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If substance use disorder treatment more than offsets its costs, why don't more medical centers want to provide it? A budget impact analysis in the Veterans Health Administration.


Given that many studies have reported that the costs of substance use disorder (SUD) treatment are more than offset by other savings (e.g., in health care, in criminal justice, in foster care), why haven't health care system managers rushed to expand treatment? This article attempts to explain this puzzling discrepancy by analyzing 1998-2006 data from the national Veterans Affairs (VA) health care system. The main outcome measures were annual cost and utilization for VA SUD-diagnosed patients. The key independent variable was the medical centers' annual spending for SUD treatment. There was no evidence that SUD spending was associated with lower medical center costs over time within the medical center that paid for the treatment. Health care system managers may not be influenced by research suggesting that the costs of SUD treatment are more than fully offset because they bear the cost of providing treatment while the savings largely accrue to other systems.


  • Publisher Full Text
  • Authors+Show Affiliations


    Veterans Affairs and Stanford University Medical Centers, Palo Alto, CA, USA.



    Journal of substance abuse treatment 41:3 2011 Oct pg 243-51


    Ambulatory Care
    Databases, Factual
    Health Expenditures
    Hospitals, Veterans
    Residential Treatment
    Sensitivity and Specificity
    Substance-Related Disorders
    United States
    United States Department of Veterans Affairs
    Veterans Health

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.



    PubMed ID